Ob-Gyn Coding Alert

Question: Patient had hysteroscopy with lysis of adhesions and a dilation and curettage (D&C). Diagnoses are infertility and Asherman’s syndrome. Path report for curettage shows “Placental site nodule,” “islands of intermediate trophoblast,” and “HCG and inhibin are weakly positive.” I queried the MD if he considered this to be a hydatidiform mole or something else pertaining to products of conception. The ob-gyn discussed with pathologist who believes it is a remnant of placental tissue after the last delivery, which was two years ago. Placenta had been manually removed. Would O73.1 and O94 be appropriate as diagnosis codes in this case, even if delivery was two years ago?

Tennessee Subscriber

Answer: If the purpose of the surgery was to treat a condition due to being pregnant, it is a postpartum condition no matter how long ago the pregnancy transpired.  

The problem is if you use O73.1 (Retained portions of placenta and membranes, without hemorrhage) and O94 (Sequelae of complication of pregnancy, childbirth, and the puerperium) with the hysteroscopic codes you may get a denial for procedure/diagnosis mismatch. And it would appear that the actual reason for doing the procedures was infertility and Asherman’s — not for suspected placental tissue.

Therefore, you should code these procedures with a diagnosis of uterine adhesions (N85.6, Intrauterine synechiae) and possibly N97.2 (Female infertility of uterine origin), since so much time has passed since the delivery.

You may bill both 58559 [Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method)] and 58558-51 (Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C; multiple procedure) for this surgery as there exists no CCI bundling edit, but remember that if you use a “scrubber”, it may tell you they are bundled, even if the official CCI document does not indicate that this is so simply because 58559 represents a lysis procedure.